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    Supportive Periodontal Therapy

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    menaxie
    Supportive periodontal treatment (SPT), also known as periodontal maintenance therapy, involves procedures performed at regular intervals to help periodontal patients maintain oral health after initial treatment. The goals of SPT are to prevent recurrence of periodontal disease, further disease progression, and tooth loss. Evidence shows that patients who adhere to long-term SPT programs have better periodontal health outcomes than those who do not receive ongoing maintenance. SPT begins immediately after initial non-surgical treatment and involves ongoing examination, reinforcement of oral hygiene practices, and treatment if needed to control periodontal disease.

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    Supportive Periodontal Therapy

    Uploaded by

    menaxie
    171 views53 pages
    Supportive periodontal treatment (SPT), also known as periodontal maintenance therapy, involves procedures performed at regular intervals to help periodontal patients maintain oral health after initial treatment. The goals of SPT are to prevent recurrence of periodontal disease, further disease progression, and tooth loss. Evidence shows that patients who adhere to long-term SPT programs have better periodontal health outcomes than those who do not receive ongoing maintenance. SPT begins immediately after initial non-surgical treatment and involves ongoing examination, reinforcement of oral hygiene practices, and treatment if needed to control periodontal disease.

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    Supportive periodontal treatment (SPT), also known as periodontal maintenance therapy, involves procedures performed at regular intervals to help periodontal patients maintain oral health after initial treatment. The goals of SPT are to prevent recurrence of periodontal disease, further disease progression, and tooth loss. Evidence shows that patients who adhere to long-term SPT programs have better periodontal health outcomes than those who do not receive ongoing maintenance. SPT begins immediately after initial non-surgical treatment and involves ongoing examination, reinforcement of oral hygiene practices, and treatment if needed to control periodontal disease.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    171 views53 pages

    Supportive Periodontal Therapy

    Uploaded by

    menaxie
    Supportive periodontal treatment (SPT), also known as periodontal maintenance therapy, involves procedures performed at regular intervals to help periodontal patients maintain oral health after initial treatment. The goals of SPT are to prevent recurrence of periodontal disease, further disease progression, and tooth loss. Evidence shows that patients who adhere to long-term SPT programs have better periodontal health outcomes than those who do not receive ongoing maintenance. SPT begins immediately after initial non-surgical treatment and involves ongoing examination, reinforcement of oral hygiene practices, and treatment if needed to control periodontal disease.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 53

    Supportive Periodontal Treatment

    Meenakshi Khasa

    MDS II yr
    Dept. of Periodontics D.A.V. Dental College, Yamunanagar

    What is SPT?
    procedures performed at selected intervals to assist the periodontal patient in maintaining oral health.

    The third world workshop of the AAP in 1989 coined the term Supportive periodontal therapy.

    also known as
    Periodontal maintenance therapy. Preventive maintenance. Recall maintenance.

    Classically: the 4th stage of periodontal treatment & treatment planning.

    Objectives
    Early recognition of disease
    Prevent the recurrence of disease Prevent further advancement of disease

    Sequence of SPT in Periodontal Treatment Phase

    Incorrect sequence
    Phase I
    Reevaluation

    Phase II (surgical phase)

    Phase III (restorative)

    Phase IV

    Correct sequence
    Phase I

    Reevaluation

    Phase IV (SPT) Phase II Phase III

    (Periodontal surgery)

    (Restorative)

    Whats the evidence?


    Patients maintained on long term maintenance programs have:
    Better periodontal health Better dental condition Better tooth preservation
    (Axelsson & Lindhe, 1978; 1981)

    Patients who were not maintained had:

    deeper pockets, more bone loss & tooth loss.


    Caries.
    (Axelsson & Lindhe, 1981)

    (Becker & Becker, 1984)

    The more often patients present for SPT, the less likely they are to lose teeth
    (Wilson et al, 1987)

    People who fail to attend regular recall are at 5.6 times greater risk of losing teeth than people who attend SPT.
    (Checchi et al, 2002)

    Inadequate SPT after successful regenerative therapy:


    50-fold increase in risk of attachment loss (CAL), compared to patients with regular SPT.
    (Cortellini et al, 1994)

    Why?

    What is the rationale?


    tooth loss inversely proportional to SPT frequency

    Accumulation of plaque results in the development of gingivitis, & its removal & control result in the resolution of the lesion in humans

    Le et al (1965)

    Subgingival plaque forms from the apical downgrowth of supragingival plaque.

    (Listgarten, 1975)

    Axelsson & Lindhe, 1978


    It is possible with regular instructions & prophylaxis to stimulate adults to adopt proper oral hygiene habits. Persons who practice good OH have negligible signs of gingivitis, no attachment loss & no caries Persons who received only symptomatic treatment had gingivitis, AL, caries & recurrent caries.

    Plaque control leads to change in the ecology of the periodontal crevice/pocket by resolution of inflammation.

    Plaque Control is the 1st step periodontal treatment planning Should be appointment reinforced in

    in

    every control,

    Without proper plaque Periodontal treatment will

    Fail

    Sc vs OHI in maintaining periodontal health: :more OHI & less Sc is better than more Sc & less OHI.
    (Lightner, 1971)

    When does SPT Start?


    Immediately after phase I

    Why?
    Because periodontal diseases may RECUR

    Reasons for Recurrence


    1.Incomplete removal of subgingival plaque Re-established within 2-3 months

    Doesnt always cause visible changes


    (you have to probe)

    2. Inadequate plaque control by the patient

    3. Healing after SRP is usually by long junctional epithelium

    may be less resistant to spread of inflammation

    4. Inadequate restorations 5. Systemic diseases/conditions

    These factors do not initiate periodontitis but predispose to it

    Research has shown that subgingival scaling alters the microflora of periodontal pockets
    (Rosenberg et al, 1981)

    Even supragingival scaling does so to a lower extent


    (Katsanoulas et al, 1992)

    One study

    Single session of SRP:

    1 week: less motile microorganisms


    21 days: more cocci 7 weeks: reduced spirochetes
    (Mosques, Listgarten & Phillips, 1980)

    Therapeutic goals for SPT


    To prevent or minimize the recurrence and progression of periodontal disease in patients who have been previously treated for periodontal diseases.

    To prevent or reduce the incidence of tooth loss by monitoring the dentition and any prosthetic replacements of the natural teeth. To increase the probability of locating and treating, in a timely manner, other diseases or conditions within the oral cavity.

    Continuous multilevel risk assessment

    SUBJECT RISK ASSESSMENT


    Lang and Tonetti 2003 purposed functional diagram for patients risk assessment for recurrence of periodontitis is evaluated on the basis of a number of clinical conditions.
    Percentage of sites with bleeding on probing Prevalence of pockets greater than 4 mm Loss of teeth from a total of 28 teeth Loss of periodontal support in relation to patients age Systemic and genetic conditions Environmental factors

    Percentage of sites with bleeding on probing

    Joss et al 1994 a BOP prevalence of 25% has been the cut off point between pat with maintained pdl stability for 4 yrs and pat with recurrent disease in the same time frame. <10 % - Low risk
    >25% - High risk

    Prevalence of residual pockets > 4mm No of residual pockets with > 5mm is a risk indicator 4 residual pockets low risk

    >8 residual pockets high risk

    Loss of teeth from a total of 28 teeth Upto 4 teeth lost low risk > 8 teeth lost high risk

    Lost of periodontal support in relation to patients age

    The extent and prevalence of pdl attachment loss as evaluated by the height of the alveolar bone on RG. 1mm = 10% bone loss
    % is then divided by patients age (BL/age). This results in a factor. 0.25 0.50 low risk 1 high risk

    Systemic conditions

    Systemic conditions like diabetes modify the progression of pdl disease

    Smoking

    Non smokers and former smokers (>5yrs since cessation) low risk
    Heavy smokers (> 1 pack per day)high risk

    Calculating the patients individual periodontal risk assessment(PRA)


    Low PR pat all parameters within low risk categories or at most one parameter in moderate risk category Moderate PR pat at least 2 parameters in mod risk category and at most 1 parameter in high risk category High PR pat at least 2 parameters in high risk category

    TOOTH RISK ASSESSMENT


    Tooth position within dental arch
    Furcation involvement Iatrogenic factors Residual pdl support Mobility

    SITE RISK ASSESSMENT


    Bleeding on probing
    Probing depth and loss of attachment suppuration

    The Maintenance Program


    3 parts:
    Examination

    Treatment & OH reinforcement


    Scheduling the next appointment (perio, restorative, orthoetc)

    Part I - Examination
    aprox time: 14 mins

    Medical history changes Dental history Look for changes: oral mucosa & gingiva Oral hygiene status Pocket depth changes Mobility changes Recession Occlusal changes Restorative, prosthetic & implant status

    Radiographic examination of recall patients for SPT


    Patient condition/situation Clinical caries or high risk factor for caries Clinical caries and no high risk factor for caries Periodontal disease not under good control History of pdl t/t with disease under good control Root form dental implants Type of examination Posterior bite wing at 12-18 month intervals Posterior bite wing at 24-36 month intervals Periapical or bitewing RG of problem areas every 12-24 months; full mouth series 3-5 yrs Bitewing RG every 24-36 months; full mouth series every 5 yrs Periapical or bitewing RG at 6,12 and 36 months after prosthetic placement, then every 36 months unless clinical problems arise If full mouth series taken within 24 months, RG of implants and pdl problem areas

    Transfer of periodontal or implant maintenance patients

    Part II - Treatment
    aprox. Time 36 mins

    Oral hygiene reinforcement Scaling and Polishing Chemical irrigation or site specific antimicrobial placement

    Notice That
    You should not repeat Phase I again, but unfortunately, you repeat treatment for many of your patients WHY?
    Inadequate/improper motivation & OHI

    No reinforcement.

    Take care not to instrument (subgingivally) normal sites with shallow PD (1-3 mm) as repeated SRP in shallow sites loss of attachment (Lindhe, Nyman & Karring, 1982)

    Uninstructed patients
    Spend 39 sec on average cleaning their teeth Remove about 60% of plaque (those who brush) Keep doing what they are used to do

    Instructed patients
    Have less plaque,
    gingivitis,
    periodontitis, caries and tooth loss

    Part III -Report, clean up, scheduling


    aprox. Time 10 mins

    Write report in chart


    Discuss report with patient Clean & disinfect operatory Schedule next recall visit

    Classification of Maintenance patients


    Classified after 1st yr of trt. & SPT

    Class A, B, C

    Recall Visits
    Arrange recall convenient to yourself visits, which the patient are and

    Recall programs for SPT must be tailored for each patient

    When Does SPT End? Never!

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